NHS versus Kaiser Permanente in California

pickledpepperRN · Feb 6, 2004

The registered nurses of the California Nurses Association can take some credit for Kaisers quality of care. The RNs refused to agree to a "partnership" that would gag their ability to advocate for patients.

http://www.calnurse.org/cna/news/sfg5799.html

Labor Peace Plan: Most unions laud novel Kaiser partnership, but nurses remain skeptical

..."CNA willingness to confront Kaiser, not just on pay hikes, but on issues like Kaiser's bid to close its hospital in Oakland, make it a better consumer advocate than the ``deal-cutters''."

The link below explains the CNA position.

http://www.calnurse.org/cna/pdf/KaiserJob.pdf

http://www.nurses.com/content/news/article.asp?docid=%7b71eec101-bd3e-11d6-a78b-00d0b7694f32%7d&VNETCOOKIE=NO

California Nurses Association Wins Mandatory Overtime Ban, Record Gains at Kaiser Permanente in Nation's Largest RN Contract 9/6/2002

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/1995/11/02/MN27167.DTL

http://www.sfgate.com/cgi-bin/examiner/article.cgi?year=1997&month=05&day=08&article=NEWS3484.dtl

http://www.sfgate.com/cgi-bin/article.cgi?file=/examiner/archive/1998/02/24/NEWS12618.dtl

Vallejo sisters Elaine and Reggie De La Cruz, who are both Kaiser nurses, walked the picket line shoulder to shoulder carrying signs reading, "Stop Downsizing Patient Care," and "Patients Come First."

"We believe that patient care is most important," Reggie De La Cruz said. "Kaiser is just not giving it to them right now."

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/1997/07/17/MN69798.DTL

Just as the country's first and largest nonprofit health maintenance organization is poised to abandon outmoded buildings and pare costs, it is under attack from regulators, politicians, patients and even its own staff for substandard care.

Kaiser's wild policy swings fuel critics' doubts and suspicions. The most extreme example: After winning approval for a new hospital in Emeryville to replace its 13-story Oakland flagship, Kaiser announced last year that it would instead farm out patients to other hospitals.

``Aside from the vague overall plan they have to screw everybody, they don't even have their act together to do it,'' said Joan Bloom, a nurse practitioner and union leader at the Oakland hospital.

But most complaints center on access to routine care. Patients, especially those who do not learn to ``work'' the system, often end up with unfamiliar doctors or long waits for nonurgent appointments.

Lately, trouble on Kaiser's home turf in the East Bay has raised questions beyond Kaiser's maddening phone system and occasionally gruff clerks.

The deaths of four patients transferred by ambulance from the minimal emergency room in Richmond brought Kaiser under state and federal scrutiny this spring. A fifth man died after walking out of the emergency room, frustrated with the delay in finding him an intensive-care bed in another hospital.

No one knows if those critically ill patients, including a heart transplant candidate, would have survived if they had received care more quickly. Licensing investigators also criticized the emergency room for sending 10 patients elsewhere without providing an ambulance. Those patients included a man with appendicitis, an infant with breathing trouble and seven women in labor.

The 10th patient, a 71-year-old man, was given two doses of the narcotic painkiller Demerol and sent to the Oakland emergency room without any record of whether he had someone to drive him or whether he was told he shouldn't drive.

The 103-page licensing report lists hundreds of more mundane yet potentially dangerous deficiencies. For example, investigators found a refrigerator 10 degrees too warm for the medicine it contained. Employees said the door latch had been broken for ``weeks'' or ``months.''

Facing what would have been the catastrophic loss of its ability to treat Medicare patients, Kaiser admitted it had made mistakes and corrected life-threatening problems by the July 1 deadline, earning praise from regulators.

http://www.calnurse.org/cna/news/cc72498.html

The hospital bed ratio in Contra Costa has likely worsened in the past three years with the closure of Kaiser Martinez and the end of inpatient services at Kaiser Richmond.

Alameda County's hospital bed and nurse ratios were higher, but still below national averages, according to the Dartmouth Atlas of Health Care.

The study was immediately seized upon by those who say the East Bay is running critically short of emergency medical care services -- and is poised for further problems as hospitals merge and close.

Debate on the issue has raged since last year, when long emergency room delays and several patient deaths were blamed on staff and bed shortages in the region. Concern rose this winter when an unusually busy flu season crowded hospitals throughout the state.

"The problems this winter were not merely a reflection of the flu season, but of the drastic restructuring and downsizing that has occurred in California and the East Bay in particular," said Chuck Idelson, spokesman for the California Nurses Association. "There is no margin for error any longer in these communities."

http://www.calnurse.org/cna/news/pd81898.html

Kaiser Permanente Hospital in Santa Rosa has been cited by the state Department of Health Services for allowing a technician to perform medical procedures during orthopedic operations.

Kaiser has agreed to stop the practice, and no penalties are being imposed.

The Santa Rosa hospital is the third Kaiser facility to be cited by the state for using an unlicensed assistant during operations

The investigation of Kaiser in Santa Rosa, conducted in June and completed Aug. 7, revealed that the hospital's four orthopedic surgeons were using an orthopedic assistant, who is a technician, to perform such procedures as suturing deep tissue wounds, placing pins in bones and cauterizing veins.

The orthopedic assistant at Kaiser, whose name was not disclosed, had no formal training beyond a 26-week course from an orthopedic device company. He was not licensed as a nurse or even as an operating room technician, Becker said.

Kaiser, however, said the assistant was an unusually talented technician and was capable of the tasks he performed

The department's investigation was triggered by a complaint by the California Nurses Association, the union that represents Kaiser nurses. The union has often raised concerns about Kaiser's use of technicians rather than registered nurses.

MORE LINKS:

http://www.calnurse.org/cna/kaiser/newsarch.html

donmurray · Feb 6, 2004

Original Post....."Pure hogwash" or simple propaganda?

Total rebuttal came swiftly to the bmj. I presume that the Harvard medical school has some standing in the USA?

Price adjustments falsify comparison

EDITORThe NHS is little cheaper than health care in the United States, according to Feachem et al.1 What's next on their agenda? War is peace? Freedom is slavery? The authors purport to show Kaiser's efficiency relative to the NHS. This task is hard, given two undisputed facts: firstly, the United Kingdom's per capita health expenditure is $1569, the United States's $4358; and secondly, Kaiser's casemix adjusted costs are about average for the United States. Undeterred, Feacham et al use an outrageous price adjustment, exclude many of Kaiser's costs, and ignore Kaiser's avoidance of the sickest and most expensive patients.

Feachem et al's price adjustment inflates NHS costs by 52%, assuming that the NHS plays no part in constraining drug prices, administrators' or specialists' incomes, etc. Conversely, the adjustment excuses the US system from responsibility for the world's highest drug costs and the billions wasted on healthcare executives and other hangers on. Feachem et al adjust away the price controls that are an important advantage of non-market systems.

Feachem et al trim Kaiser's costs by subtracting profits and high administrative expenses. Yet both are integral to the competitive market they extol. They falsely equate Kaiser's coverage with the NHS's, although Kaiser covers only miniscule amounts of nursing home care. Finally, many Kaiser patientsmore than 12% according to a Kaiser memoreceive care outside Kaiser, costs which the authors exclude. Thus, Feachem et al understate Kaiser's actual costs.

Contrary to Feachem et al's assertions, Kaiser cares for a relatively inexpensive slice of the population. Their claim that Kaiser cannot avoid the expensively ill by booting them out is technically correct; when Kaiser members lose their jobs (for example, because of illness) and hence employer paid coverage, Kaiser must offer them individual policies. But Kaiser may charge whatever it likesoften thousands per month. Hence, few of the unemployed can actually afford coverage. Moreover, because the overwhelming majority join Kaiser through work, severely disabled people rarely get in. Although disabled Medicare patients may join, few do. Hence, Feachem et al's failure to adjust for casemix grossly biases cost comparisons; their adjustments for age and income are inadequate substitutes.

Finally, Kaiser's premiums (and costs) are virtually identical to those of other insurers that serve similarly healthy populations. Hence, Feachem et al's claim for Kaiser is tantamount to a claim that $1569=$4358.

The NHS has grave problems, and Kaiser is far from the worst of US health care. However, Feachem et al's conclusions are pure hogwash.

David U Himmelstein, associate professor of medicine.

Steffie Woolhandler, associate professor of medicine.

Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, USA

pickledpepperRN · Feb 6, 2004

I have first hand experience with the finest and most greedy sides of Kaiser.

The patients are truly from the middle, working people. Nice to go through the registry and care for those patients who actually realize that nurses are working people too.

No big show biz muckety mucks (some of whom are very nice).

No homeless people either.

Read the links above for some of the bad. Mostly Kaiser provides as Dr. David Himmelstein and Steffie Woolhandler describe as neither the best nor the worst.

It should not be necessary for a sick person to become educated in how to work the system in order to receive the care they already paid for.

NurseHardee · Feb 7, 2004

I have both worked at Kaiser and tried to access care there for 3 different people in my immediate family. The best I can come up with is to simply say that Kaiser is an atrocity.

I sincerely doubt the validity of this conclusion to this "study", though. It was published by the British equivalent of the AMA, and I have about as much cynicism to their supposed lack of bias as I would towards the pro-corporate AMA stuff.

Further, KP doesn't service the whole community, but rather what I would call the "Sam's Club" community. It is "Sam's Club" care, not community public health care. If the results are the equal to a national health service, then the national health service is performing at a much better level than KP does.

Comparing a narrow spectrum of American care to the entire spectrum of care in another country is utterly a false methodolgy. Kind of like many of the AMA studies on other themes.

Nurse Hardee

pickledpepperRN · Feb 7, 2004

Originally posted by NurseHardee
Comparing a narrow spectrum of American care to the entire spectrum of care in another country is utterly a false methodolgy
Nurse Hardee

So true.

Kaiser patients by definition pay for health insurance.

NHS provides care to all.

Why California ONLY for the Kaiser stats?

donmurray · Feb 7, 2004

I assumed (foolish, I know!) that the populations were around the same, but the UK is just under 60 million to California's 32 m. What an empty country you have! LOL:D

We all pay health insurance too, but to the Government, around 9% deducted from pay, and slightly more than matched by the employer's contribution. That also covers a basic old age pension payable from age 65.

Our Universal Healthcare system can't be too bad as recently we have had a problem with "health tourists" from other countries (including the USA) who come to visit, pay no contributions but play the system to have free elective surgery whilst here. Dealing with freeloaders bumps up the waiting times! :eek:

fergus51 · Feb 8, 2004

I would think a better comparison would be to compare those on medicare with those in the NHS. It seems a little odd to compare Kaiser people (who by definition need to be of a certain economic level) to people on the NHS (who are seldom the wealthier members of the UK). It would also seem that you need to evaluate the care based on the actual money spent.

But facts don't seem to matter. It's perception that counts.

donmurray · Feb 8, 2004

Nobody said there are no problems...

Private operations 'costing NHS 40% more'

Tash Shifrin

Tuesday October 28, 2003

The Guardian

The NHS is paying 40% more for operations in the private sector than the same procedures would cost if they were carried out in NHS hospitals, MPs have been told.

NHS trusts have been encouraged by the government, under a concordat agreed with the private healthcare industry, to buy operations in the private sector to drive waiting lists down.

But the finance director of the NHS, Richard Douglas, was last week forced to admit that figures produced by the thinktank Office for Health Economics showing that prices paid to private sector providers for common operations such as hip replacements and cataract surgery, were running at about 40% higher than NHS reference costs.

The figures revealed by Conservative committee member Simon Burns showed that the average price charged by the private sector for cataract operations was £922, compared with £632 for operations carried out in the NHS - making the private procedure 46% more expensive than the NHS operation.

Hip replacements were 33% more expensive, costing £5,777 in the private sector and £4,356 in the NHS, while knee replacements cost 44% more at £6,914 compared with an NHS price of £4,817. Coronary bypass grafts were 40% more expensive in the private sector at £8,761 compared with £6,273.

Mr Burns pressed repeatedly before Mr Douglas admitted that the analysis was "a reasonable piece of work".

Mr Douglas admitted that the NHS was "paying a premium above NHS costs", arguing that this was "because we are buying capacity that is not there in the NHS".

He said: "Comparing the average cost for things that we provide generally in the NHS with something that we have to buy to meet our overall service standards, it is not unreasonable that we will pay something higher."

But Mr Burns argued: "One does get the impression that, to meet political targets so that ministers are not embarrassed, the government will do almost anything to get people their operations."

John Bacon, the NHS's group director of health and healthcare services, told MPs that "in order to meet what we think are very important standards of performance", the NHS had used the private sector "in perhaps not the most cost-effective way" and was looking to "expand the capacity of the NHS rapidly over the next three to five years" and make longer-term block purchasing arrangements with the private sector rather than "spot contracts" for individual cases. This move included the independent treatment centre programme, where five-year contracts had been drawn up, he said.

The treatment centres - dubbed surgery factories - which will be run by mainly overseas companies, have themselves come under fire because the private firms will be paid more than NHS providers for operations and are expected to take the bulk of their staff from the NHS on secondment.